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Several people have asked me about my thoughts on a regular PrEP user acquiring HIV, since I'm a big PrEP advocate.

Generally speaking, it was always expected: 99% effective meant 99% effective, and the number of people who get HIV despite their use of PrEP will depend on how many nines go after the decimal place, which researchers are still figuring out.

As far as any "told ya so" or "this is why you should be using condoms!" business, this remains as absurd as it was before. Condoms were not 100% effective; if you factor in the risk of them breaking, you still don't come close to the effectiveness of PrEP.

Knowing that, it's hard to understand what the haters are really talking about. If they were advocating for PrEP and condoms, it would make some modicum of sense (it doesn't, but I'll get to that in a moment). But what they're really advocating for is the idea that condoms were an effective means of preventing HIV, when in reality, they weren't. For all intents and purposes, PrEP has replaced the condom as the most effective means of HIV prevention.

As far as that point I promised I would get to, the haters are the same people who would have told you (and probably will still tell you) that now that we have both, we should be using both (as in, airbags did not eliminate the utility of seatbelts). And in the same breath, they will talk about their many sexcapades in which they were only using condoms, but not PrEP. The implication is that some big orgy with condoms is fundamentally safer than the same big orgy with PrEP—which is false. PrEP works better at preventing HIV than a condom does. Period. Full stop.

This finger wagging also sets up a false dichotomy between condoms and PrEP, when those mechanisms can and should be paired with other safe sex actions, such as, (gasp!) talking frankly with sex partners about STIs, testing, and the like.

In short, it is completely absurd for someone who only uses condoms to get all judgemental about someone only using PrEP to prevent HIV (and mitigating the risk of other STIs some other way, if at all). It is also a dangerous message, because safe(r) sex means drawing on a great many tools, including affordable healthcare, frank conversations, condoms, PrEP, etc.

Lastly, one user worldwide (and I realize, more will come) falls within the acceptable risk level for most people, and most people do many other far more dangerous things on a daily basis. If you ever (as in EVER) drive on I-285, you are risking your life more than sleeping with any cum dumpster in your rolodex of people willing to toss you a sympathy fuck. I'm talking to you, (redacted).

Actual vaccines don't have 100% effectiveness rates—they often work because the high nineties is close enough to create herd immunity.

The fact that anyone would flinch about what has become a statistically remote chance of getting HIV on PrEP really just speaks to how much stigma surrounds HIV itself. That people cling so fiercely to the pursuit of 100% in their own lives (or impose it on others) says more about the fear they have of becoming part of the population they have heretofore stigmatized, than about a genuine desire to stop HIV/AIDS.